Let’s face it: any time is a bad time when it comes to having your period. For most women, cramping and bloating are typical symptoms of the “friend” who pays a monthly visit. But when the pain is extreme and paired with excessive bleeding, fever, or feels suddenly worse than what has been previously experienced, it’s time to see your doctor.

A Normal Flow

The average amount of menstrual flow (measured in a laboratory from all collected tampons and pads) is about two tablespoons (30 ml) in a whole period. However, according to the Centre for Menstrual Cycle and Ovulation Research, the amount of flow is highly variable, ranging from a mere spot to over two cups (540 ml) in one period. Their studies found that women who are taller, have had children, and are in perimenopause have the heaviest flow, and the usual length of menstrual bleeding is four to six days.

The flow and duration alone may not be likely indicators of an underlying problem. What you need to look out for are changes during the cycle. “If your periods are getting heavier or your cramps are getting worse over time (over 2 or 3 months), I would recommend getting evaluated to see what’s going on,” said Melani Harker, MD, Obstetrics & Gynecology at University of Utah Health Care

Cramping

Most of us don’t notice the contractions that occur regularly in our uterus—not until our periods, at least. During menstruation, uterine contractions are strong and painful, and these contractions are the menstrual cramps.

There are a variety of remedies. “Many of them are based on personal preference, so find what works for you,” says Harker. “Any form of ibuprofen, Aleve, or Naprosyn is often recommended.” Naprosyn, a type of nonsteroidal anti-inflammatory drug (NSAID), works by lowering prostaglandins levels in the body. “If you can reduce these naturally occurring hormone-like chemicals before your period, you can decrease the pain,” Harker adds. “When taken a couple of days before the worst symptoms appear, women will experience less pain.” Other women have used a heating pad, a hot bath, even acupuncture to alleviate the menstrual discomfort.

More than half of women experience menstrual cramping (or dysmenorrhea). But there is a difference between uncomfortable cramps, which are normal, and the downright painful, take-time-off-work cramps, which may be a signal that something serious is going on.

Signs to Watch

Most pain relievers should relieve menstrual discomfort, but if the pain doesn’t respond to medication, it could be a symptom of something more serious. Also concerning is pain that spreads to other parts of the body. “If pain is more acute in onset or it radiates into the back or down the leg, it’s time to talk with your doctor,” says Harker. Also, be sure to discuss any pain associated with nausea or pain that’s way out of the ordinary.

While it may not be the most pleasant of experiences, a regular menstrual cycle is an important part of women’s health. By monitoring period pain, women can be sure they are addressing problem areas and getting the care they need for personal wellness.